Use of Procalcitonin to Reduce Patients’ Exposure to Antibiotics in Intensive Care Units (PRORATA trial): A Multicenter Randomized Controlled Trial

Background. Inappropriate use of antibiotics in the intensive care unit (ICU) is associated with antimicrobial resistance, which can affect patient outcomes. Procalcitonin, a calcitonin precursor hormone, is a specific marker for bacterial infection in patients with sepsis.

The objective of the study was to determine whether an algorithm derived from the biomarker procalcitonin is effective in decreasing antibiotic exposure in the ICU.

Methods. Bouadmaand colleagues conducted a multicenter, prospective, open-label trial, randomly assigning critically ill patients with suspected bacterial infections to a procalcitonin group or a control group. In the procalcitonin group, antibiotics were started and stopped according to predefined cut-off ranges of calcitonin, whereas current guidelines were used to dictate antibiotic therapy in the control group. Primary endpoints were 28- and 60-day mortality (noninferiority) and number of days without antibiotics by day 28.

Results. There was no difference in mortality between the procalcitonin group and the control group. Patients in the procalcitonin group had 2.7 more days without antibiotics than patients in the control group.

Procalcitonin has been studied as a biomarker of infection and may provide a better means by which to manage critically ill patients. This article highlights a potential method for guiding antibiotic use that may reduce unnecessary antibiotic use and, consequently, antibiotic resistance. Although the results are positive, of particular interest is that 53% of patients in the procalcitonin group were not managed by the designated protocol but were instead managed according to the clinician’s opinion of what was appropriate.

Furthermore, because the study was conducted primarily in medical patients, it is not generalizable to surgical patients. Future studies are necessary to confirm the use of this test for antibiotic management in the critically ill surgical and medical patient.